modified laparoscopic transcystic biliary drainage in the management of cholecystocholedocholithiasis

Conditions: Common Bile Duct Calculi; Acute; Cholecystitis, Choledocholithiasis; Acute Cholecystitis With Obstruction; Acute Cholangitis

Summary: the modified laparoscopic transcystic biliary drainage which we developed in the treatment of cholecystocholedocholithiasis has some advantages over conventional techniques. here, a 7-fr triple-lumen 30-cm central venous catheter was adopted to replace conventional 5-fr ureteral catheter, which extended the function of the c-tube. then we developed a continued suture and circling manner by the v-loc closure device, which simultaneously covered and anchored the c-tube. theoretically, this modified laparoscopic transcystic drainage not only provide safe and effective bile duct drainage, but also provide a convenient access of treatment for postoperatively retained bile duct stones, which may expand the indication of initially laparoscopic operation in the management of cholecysto-choledocholithiasis.

the modified laparoscopic transcystic biliary drainage which we developed in the treatment of cholecystocholedocholithiasis has some advantages over conventional techniques. here, a 7-fr triple-lumen 30-cm central venous catheter was adopted (arrow international inc., pennsylvania, u.s.a.) to replace conventional 5-fr ureteral catheter, which extended the function of the c-tube. then we developed a continued suture and circling manner by the v-loc closure device (covidien v-loc 180 3-0®, mansfield, ma, us), which simultaneously covered and anchored the c-tube. furthermore, the catheter was introduced through the abdominal wall located at 3 cm below the costal margin on the midaxillary line/the posterior axillary line, which was traditionally performed at the point below the midclavicular line on the right side. our modified path could avoid the compression of the c-tube by hepatic margin and hence decrease the dislocation of the c-tube. in addition, the retroperitoneal path may increase adherence development and sinus-tract formation. more importantly, this path could easily be available when the patient be placed in the prone position for ercp, which can conveniently facilitate the guidewire passed through the c-tube down to the duodenum to perform postoperative rendezvous technique. theoretically, this modified laparoscopic transcystic drainage not only provide safe and effective bile duct drainage, but also provide a convenient access of treatment for postoperatively retained bile duct stones, which may expand the indication of initially laparoscopic operation in the management of cholecysto-choledocholithiasis.

Eligibility criteria:
inclusion criteria: * patients ≥ 18 years of age; * patients with gallbladder stones and known or expected concomitant bile duct stones; * informed consent. exclusion criteria: * biliary drainage is already present, e.g. preoperative enbd, ptcd; * women who are pregnant; * declined consent; * inability to follow the procedures of the study, e.g. due to language problems and psychological disorders of the participant; * morbid obesity (bmi \> 40); * iv-vi class of the american society of anesthesiologists physical status classification; * contraindications for general anesthesia or surgery.